Invokana (canagliflozin) is a prescription medication used to treat type 2 diabetes, with additional approved uses for protecting the heart and kidneys in people with diabetes. It belongs to a class of drugs called SGLT2 inhibitors, which work through the kidneys rather than the pancreas to lower blood sugar. Taken as a once-daily tablet, it has become a cornerstone medication for people with type 2 diabetes who also have cardiovascular disease or chronic kidney disease.
How Invokana Works
Your kidneys filter about 180 grams of glucose from your blood every day, then reabsorb nearly all of it back into the bloodstream. A specific protein in the kidneys handles 90 to 97% of that reabsorption. Invokana blocks this protein, causing your body to flush excess glucose out through urine instead of recycling it. This lowers blood sugar without relying on insulin production or sensitivity.
The result is a drop in HbA1c (a measure of average blood sugar over three months) of roughly 0.5 to 1 percentage point. Your body does compensate partially, with a backup system in the kidneys picking up some of the glucose that Invokana blocks, but the net effect is still a meaningful reduction in blood sugar levels. Because the drug works through the kidneys rather than the pancreas, it pairs well with other diabetes medications that use different pathways.
Cardiovascular Protection
Beyond blood sugar control, Invokana carries an FDA-approved indication for reducing the risk of major cardiovascular events, specifically heart attack, stroke, and cardiovascular death, in adults with type 2 diabetes and established heart disease. In the large CANVAS clinical trial, adding Invokana to standard care reduced the risk of these combined events by 14% compared to placebo. Among patients who already had confirmed cardiovascular disease, the reduction was 18%.
The American Diabetes Association’s 2025 treatment guidelines recommend SGLT2 inhibitors like Invokana for people with type 2 diabetes who have heart failure, regardless of their blood sugar levels. This reflects a shift in how these medications are viewed: they’re no longer just glucose-lowering drugs but tools for protecting the cardiovascular system.
Kidney Disease Risk Reduction
Invokana is also approved to reduce the risk of end-stage kidney disease, worsening kidney function, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes and chronic kidney disease. The landmark CREDENCE trial, published in the New England Journal of Medicine, demonstrated these protective effects and made Invokana one of the first diabetes drugs shown to meaningfully slow kidney disease progression.
Current ADA guidelines recommend SGLT2 inhibitors for people with type 2 diabetes whose kidney filtration rate falls between 20 and 60 mL/min/1.73 m² or who have significant protein in their urine. The guidelines note this recommendation holds regardless of A1C levels, meaning the kidney and heart benefits justify use even when blood sugar is already well controlled. However, the blood sugar-lowering effect of Invokana diminishes as kidney function declines below a certain threshold, since the drug depends on the kidneys to work.
How to Take It
The standard dose is 100 mg once daily, taken before your first meal of the day. Because Invokana increases urination (a natural consequence of flushing extra glucose), staying well hydrated is important. The extra fluid loss can cause drops in blood pressure, especially when you first start the medication or if you’re not drinking enough.
For people with moderate kidney impairment (filtration rate between 30 and 60), the maximum dose is capped at 100 mg daily. Starting the medication isn’t recommended if your filtration rate is below 30, though there’s an exception: patients already taking Invokana who have significant protein in their urine can continue at 100 mg daily for the heart and kidney protective benefits, even as kidney function worsens past that threshold. The blood sugar-lowering effect is minimal at that point, but the organ-protective effects persist.
Common Side Effects
The most frequent side effect is genital yeast infections, which makes sense given the mechanism: more glucose in the urine creates a friendlier environment for yeast. In clinical trials, about 10.6% of women taking the 100 mg dose developed genital yeast infections, compared to 2.8% on placebo. For men, the rate was around 4.2% versus 0.7% on placebo. These infections are generally treatable with standard antifungal medications, but they can be recurrent for some people.
Urinary tract infections occurred in about 5.9% of patients on the 100 mg dose versus 3.8% on placebo, a more modest increase. Other effects related to the drug’s mechanism include increased urination and, in some people, lightheadedness from mild dehydration or lower blood pressure. These tend to be most noticeable in the first few weeks.
The Amputation Warning
Invokana previously carried a boxed warning (the FDA’s most serious safety label) about an increased risk of leg and foot amputations. The FDA has since removed that boxed warning after reviewing data from three additional clinical trials showing the risk was lower than initially reported, particularly in patients receiving appropriate monitoring. The amputation risk hasn’t been eliminated entirely. It’s still listed in the drug’s safety information, and preventative foot care remains important for anyone taking Invokana, especially those with diabetes-related nerve damage, poor circulation, or a history of foot ulcers.
Who Invokana Is Typically Prescribed For
Invokana is only approved for adults with type 2 diabetes. It is not used for type 1 diabetes. In practice, it’s most commonly prescribed for people who fall into one of three overlapping groups: those who need better blood sugar control beyond what metformin alone provides, those with type 2 diabetes and existing cardiovascular disease, and those with type 2 diabetes and chronic kidney disease. For the second and third groups, the heart and kidney benefits often drive the prescribing decision as much as, or more than, the glucose-lowering effect.
People on dialysis or with very low kidney function are not candidates for starting the drug. And because Invokana works independently of insulin, it can be combined with insulin, metformin, or other diabetes medications, though combining it with insulin or drugs that stimulate insulin production increases the chance of low blood sugar episodes.